Provider Demographics
NPI:1679263099
Name:MICHELLE K MALLOY ACUPUNCTURE AND WELLNESS INC.
Entity Type:Organization
Organization Name:MICHELLE K MALLOY ACUPUNCTURE AND WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:630-886-1450
Mailing Address - Street 1:4337 W SARAH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3837
Mailing Address - Country:US
Mailing Address - Phone:630-886-1450
Mailing Address - Fax:
Practice Address - Street 1:7223 BEVERLY BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2500
Practice Address - Country:US
Practice Address - Phone:630-886-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033822911OtherACUPUNCTURIST